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5 keys for a successful enterprise health record launch

INSIGHT ARTICLE
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October 28, 2016

Gulshan Mehta, Dan Head

An electronic health record (EHR) implementation project has consistently been a reason for intense anxiety for executives at many health care organizations. Implementation of a new EHR is a transformative change that affects the entire organization. As we have seen over the years, this impact can be substantial with respect to patient care, revenue, operational effectiveness and user satisfaction. In some cases, the implementation can be wrought with challenges as well. Projects going millions of dollars over budget, increases in patient-wait times in emergency rooms, surgeries needing to be rescheduled or cancelled because of missing supplies, incomplete checklists and billing shortfalls because of missing documentation, and system integration issues have all been reported as unfortunate byproducts of a difficult EHR implementation. The results certainly vary from one project to another and there are many factors that can influence a successful launch.

Whether it is an EHR implementation that is transitioning an organization from paper to electronic documentation for the first time or a change in EHR vendors, answering the organizational why is an important question when considering any project, especially one of this magnitude. Assuming a change was planned and implemented for all the right reasons, a vendor has been selected, contracts negotiated and you’re now formulating an implementation plan, a few guiding principles need to be established to drive this project towards a path that presents the highest likelihood of success. Consider the following five keys for a successful EHR launch:

1. Design for the future

Use this EHR implementation project as an opportunity to evaluate and redesign inefficient clinical and functional workflows in the current state. When devising the scope for this implementation, try to understand the current state first and design a system which enables the desired future state. Often an IT strategic roadmap would have been devised that looks out three to five years, and aligns with the organizational goals, with the EHR implementation as one of the projects that enables that organizational vision. Utilize this strategy throughout the planning, design and build phases of this project. Determining this future state is important when answering some key design questions.

For instance, if a new diagnostic services tower is scheduled to open six months after the project is live, when implementing a project with the future state in mind, the system design and technology planning can be made intentionally scalable to help support that initiative when it comes to fruition. Similarly, if the existing workflows are not optimized due to the capabilities of the legacy system(s) or a paper-based workflow, they should be evaluated and updated to bring an optimized workflow forward to the new system.

There is no value in implementing a new system for defunct or archaic workflows that are in need of redesign, only to alter the system build again through a new optimization effort soon after conversion. The best time to enable new EHR technology to optimize existing workflows is during the initial implementation and to account for it when creating the initial scope.

2. Embrace the standard

In recent years, most EHR vendors have aggressively documented the standard configuration settings as a guide to a successful implementation. These standards are developed by the vendors with learning from their applications utilized in the field. They take into account industry best practices when it comes to workflows and often encapsulate the system build that aligns with regulatory reporting needs.

While these EHR platforms are largely configurable and customizable, it is highly recommended to embrace the standards as the base data set and make the customizations only as necessary. This saves time in decision-making during implementation, lessens effort with respect to design and build, promotes better system performance and reliability, and complies with defined regulatory needs (like meaningful use, MACRA or MIPS). Furthermore, a closer alignment to these standards also significantly reduces the maintenance efforts such as code upgrades and enabling additional application modules or functionality in the system post-conversion.

Rationalizing the standard configuration templates and customizing some of the standard recommendations to better suit organizational needs is much better than building a completely custom build from scratch without any consideration for the standards.

3. Train for proficiency

Training the users is often a tough project task for numerous reasons. Some organizations take a lighter approach to training than desired because of costs, scheduling and time constraints, system build delays, instructor competency or schedules and the general desire to not pester the user population too much. Most organizations take a one and done approach to training where the users take an instructor-led class or a web-based training (WBT) once, and after it is completed they get their sign-on credentials awaiting the implementation of the new system.

Training once is almost never enough when learning a new system, a new process or a new way to deliver care to the patient. What we have seen work best is a classroom or WBT training coupled with established lab hours where the end users are able to practice using the system in a mocked up, real world environment. Mandating a few hours of lab time with a focus on proficiency is highly encouraged for a successful conversion.

Additionally, the training and user performance should be monitored post-conversion as well. After a new EHR implementation, it is prudent to plan for a 90-day checkpoint with the end users and provide supplemental education through trends in workflow discrepancies identified during this time period. Training the users for proficiency allows the users not only to be capable of finishing their tasks but also allows users to be efficient and highly productive at them.

4. Test everything

The most common guidance you may have heard of is to test, test and test some more when it comes to implementing a new system. While diligence in testing the system is important and can never be downplayed, a common mistake involves a lack of focus on the completeness of the testing. Too often we see what gets tested is only what is new with the project.

It cannot be emphasized enough how the testing plan should include every component in unison that will be affecting the end users’ workflow post-conversion. This is in addition to the integration tests performed across different systems as they complete a given workflow. For example, while it may seem silly during this project to focus on testing a printer which has been around for a long time, it is imperative to test it in conjunction with the new system as it pertains to new printing formats for labels, consents, barcodes and more. We have observed instances where not every model of printer was tested for the same workflow which resulted in skewed labels, barcodes that wouldn’t scan or consent forms that were cut-off. Similarly, validating that the monitor resolutions are set to the optimal levels to support the new applications will help the end users have a better experience when faced with a new system on the day of conversion.

Though the ability to test everything can seem daunting, it is essential to have a high confidence level at the time of go-live where the risk associated with the unknowns have been mitigated as best as possible.

5. Invest in go-live support

The day of conversion can be a nervous moment for all parties involved. The implementation team is finally seeing the work done over a year or more being realized, the leadership is anxious about how the system change will affect daily operations and the users are going to have to break old habits and go to work in a world where nothing is as familiar as it was the last time they were there. Even the basic act of checking their own schedules will be different.

An EHR implementation is especially different from some other technology projects where the clinical end users who are affected still have critical patient care tasks which are enabled by the EHR solution, but are not dependent on it. A degree of personalized support to function efficiently in the new system while balancing care delivery needs goes a long way. A productivity hit post-implementation is a common consideration when planning the project. The ability to recover from that productivity hit in a way that does not affect patient or financial outcomes remains crucial.

The conversion command center will be responding to calls from end users and managing huddles throughout the day to evaluate issues and communicate remediation plans. At this time, having at-the-elbow support resources for the users to help them through this transition will be of significant benefit to all involved, especially the end users. An investment in resources in the units and on the floors supporting the end users will contribute to a quicker return to normal operating levels for the end users and reduces the risk of affecting patient outcomes and billing delays. A presence of these go-live support resources will also build confidence for the end users on a new system and it will provide an effective communication mechanism to the end users on issue fixes and configuration changes. During a conversion, the communication of critical issue resolutions and significant system changes occurs via daily flyers, emails or status calls. These go-live support resources will be able to communicate these issues out more consistently and quickly compared to the other means.

An EHR implementation has the potential to be truly transformative and propel an organization towards significant value realization, when done right. The cost of the software and the services to implement is significant and the impact to the organization can be drastic. Harvesting value from this investment by improving patient outcomes with accurate and efficient revenue generation is the goal. With a large volume of EHR implementations in recent years, there is a treasure trove of information to derive insights from when planning for a successful implementation, some of these we have discussed in this article. The speed to value is within reach with a focused approach to mitigate common risks and planning for success.

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